This is a resubmission of a new application for an NICHD Institutional Training Grant in Pediatric Emergency Medicine intended to provide the Department of Pediatrics at Washington University School of Medicine (WUMS) with the funds necessary to recruit and educate qualified physician-scientists. Our long- term objective is to use this funding to promote the career development of young physician scientists who will become future leaders in biomedical research efforts dedicated to improving health outcomes for children with emergency medical conditions. The specific aims of this proposal are to identify potential trainees at the completion of their residency and to provide them with a two-year research experience in the laboratory of a qualified mentor, or with a comparably rigorous mentored patient-oriented research experience, protected from clinical and teaching responsibilities. The focus of the research will be on child health issues in pediatric emergency medicine, including high-priority patient-oriented research with emphasis on the relationship between catastrophic illness, emergency care, and long-term disabilities and molecular mechanisms of infection and immunity, cardiopulmonary disease and multiple organ dysfunction syndrome (MODS). We will achieve this goal by creating two tracks: (1) patient-oriented research, and (2) the molecular mechanisms of infection and immunity, cardiopulmonary disease, and MODS. Recent advances in cell, molecular and developmental biology will be applied to understanding the pathogenesis and treatment of infection and immunity, cardiopulmonary disease, and MODS. Similarly rigorous patient-oriented research methods will be applied to improve outcomes of high-priority emergency medical and surgical diseases, using the full facilities of the WUMS and its Department of Pediatrics. We have in place a structure in which bright, motivated, young pediatricians will flourish in a protected environment and will emerge as leaders in this evolving area of pediatrics. David M. Jaffe, M.D. and F. Sessions Cole, M.D. will be the Co-PIs and Co- Directors, and Alan L. Schwartz, Ph.D., M.D. will chair the Advisory Committee. The program (via this award and matched funds from WUMS) takes advantage of 29 established investigators who will serve as mentors. The long-term goals will be realized as its trainees contribute to the development of and leadership as pediatric physician-scientists during the next two or more decades.